NSG 155: The GI System - Ch 41 Drugs for Peptic Ulcer Disease Flashcards
H. pylori Treatment
gram-negative bacterium, commonly associated with peptic ulcer disease - anorexia, wt loss, pain after eating
Preferred Regimen:
* omeprazole or other PPI
* two or more antiinfectives: clarithormycin and amoxicillin
- may also give Pepto-bismol
- alternative antiinfectives: metronidazole and tetracycline
simethicone
Therapeutic class and administration
antiflatulent
used to treat symptoms of gas, bloating, fullness, painful pressure
Route/Administration:
* if drops, shake before administering
* usually in chewable tablet form
simethicone and post-op
Post-Op
* commonly given to post-surgical patients to help prevent trapped air - which can be painful in shoulders/back, sometimes chest, etc.
* binds to gas to break up into smaller bubbles and makes it easier for body to get rid of
* can give 4x a day?
Nursing Interventions
* early mobilization
* do not drink through draws
diphenoxylate with atropine
- brand name Lomotil
- scheduled opioid; requires Rx
- antidote for overdose is nalaxone
- do not give < 2 y.o.
- CNS depressant - drowsiness
- can prolong QT wave, cause dysrhythmias
- anticholinergic effects of atropine experienced at high doses - dries you out
- discontinue as soon as symptoms resolve
loperamide
brand name Imodium
opioid-like but has no narctoic effect eve at high doses
low dose available OTC
discontinue 48 hours after diarrhea has resolved
docusate sodium
brand name Colace
* eomollient
* stool softer - surfactant laxative
* pulls more water (also fat) into stool to soften it to make it easier to pass
* given to post-op patients on narcotics, avoid pushing or straining risk of affecting surgical site
patient teaching
* keep hydrated
* this is not going to make you go, it’s going to help you when you do need to go and reduce straining, pushing
sulfasalazine (Azulfidine)
DO NOT give if ALLERGY to:
*sulfonamide, furosemide (Lasix), or salicylates (aspirin)
Teaching:
*may turn urine orange-yellow color
*report signs of infection, fatigue, dizziness
Uses: mild to moderate ulcerative colitis; off label tx for Crohn’s Disease; alternative for rheumatoid arthritis
ADR:
* nephrotoxic
*Steven-Johnson’s Syndrome
*hepatotoxic
*crystalluria
*n/v/d
Contraindicated: renal failure, GI obstruction, GU obstruction
ondansetron
brand name: Zofran
Indications/Uses: prevention or tx of severe N/V associated with surgery, chemotherapy, or hyperemesis in pregnancy
Caution: pts with cardiac issues (drug can cause dysrhythmias)
Administration:
Routes: PO, ODT, IV
* Do not slam drug - can prolong QT interval, dysrhythmias, heart issues
ADR: most common are dizziness, headache, drowsiness (think CNS)
ADR: serotonin syndrome
promethazine
Brand name: Phenergan
Indication/Uses: motion sickness, nausea, sedation, rhinitis, allergic symptoms
Administration:
never slam
can cause SEVERE TISSUE DAMAGE with bad IV - never leave patient monitor IV site, always dilute
Effects:
anticholinergic activity (dry, constipation, urinary retention)
CNS depression - dizziness, drowsiness
psyllium
bulk-forming
#1 preferred tx first
can be taken as daily fiber supplement
psyllium (Metamucil)
stool - absorbs water and increases size
NOt for surgery prep
need to drink plenty of water - mix with at least 8 oz
avoid this type if pt iso n fluid restriction
potential cramping but less than others (esp. versus stimulant laxatives)
Crohn’s Disease
Crohn’s Disease and Ulcerative Colitis are both inflammatory bowel diseases which both have symptoms including abdominal pain, cramping, diarrhea, weight loss
Crohn’s disease is ulceration in distal part of small intestine and may occur in all layers of bowel wall
tends to reoccur after surgery
high rate of arthritis
pancrelipase
pancrelipase (Creon)
used as replacement therapy in pts with pancreatitis and cystic fibrosis
helps to digest fat and prevent steatorrhea
has pork origin - allergy or religious reasons
famotidine
Pharmacologic Class: H2 Receptor Antagonist
Therapeutic Class: antiulcer
Action: occupies/blocks H2 receptors and prevents acid secretion
Uses/Indications:
GERD, peptic ulcer disease, erosive esophagitis, hypersecretory conditions
Administration/Teaching:
PO Administration - 15 to 60 minutes before eating foods or drinking drinks that may cause heartburn
avoid antacids within 1 hr
avoid GI irritants, such as alcohol and NSAIDs
famotidine (Pepcid)
cimetidine (Tagamet)
cimetidine has a high risk of drug interactions, esp. in elderly.
Proton Pump Inhibitors (PPI)
pantoprazole (Protonix)
treat damage from gastroesophageal reflux disease (GERD), duodenal ulcers, H. Pylori
omeprazole (Prilosec)
esomeprazole (Nexium)
Action: block enzymes responsible for secreting hydrochloric acid in stomach
may see be given after surgery to protect stomach
Adverse Effects:
Risk of Deficiencies
potential for zinc and magnesium deficiencies
long-term can have vitamin B12 deficiency
long-term may have bone loss; osteoporosis, brittle-bones
acute renal failure or dysfunction
Administration/Teaching:
can be administered with or without food
report worsening symptoms, hematemesis, bright red blood, black tarry stool
avoid drugs harsh on GI system: NSAIDs, alcohol, and salicylates (aspirin)
Diarrhea Assessment:
Diarrhea Assessment:
hyperactive bowel movements
frequency
consistency, color, amount, smell
